Provider Demographics
NPI:1114934999
Name:JENSEN, KIMBERLEY R (DC)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLEY
Middle Name:R
Last Name:JENSEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 EUREKA WAY
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0816
Mailing Address - Country:US
Mailing Address - Phone:530-241-2798
Mailing Address - Fax:530-241-3066
Practice Address - Street 1:1115 EUREKA WAY
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0816
Practice Address - Country:US
Practice Address - Phone:530-241-2798
Practice Address - Fax:530-241-3066
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19769111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00958279OtherRAILROAD MEDICARE
CADC19769Medicare ID - Type Unspecified